在单侧肾脏良性肿块的治疗中，传统方法是采用部分肾切除术（PN），但是有时也需要采用根治性肾切除术（RN）。大部分单侧肾脏良性肿块的研究都集中在进行了PN的患者身上。为了全面分析治疗策略/结果并掌握对于这种具有挑战性的疾病的相关知识，我们对于1024位单侧肾脏良性肿块患者（1975-2022）进行了回顾性评估。我们分析了基线特征和病理/功能/生存结果。评估了PN/RN/冷冻消融（CA）/积极观察（AS）等治疗手段，分析了功能结果、围手术期发病率/死亡率以及5年复发率（RFS）。使用Kruskal-Wallis和卡方检验来比较患者队列，使用log-rank检验和Cox比例危险模型来进行生存分析。在1024名患者中，842名采用了PN（82%），102名采用了CA（10%），54名采用了RN（5%），26名采用了AS（3%）。肿瘤大小和RENAL指数分别为3.7cm和8。中期随访时间为53个月。在PN中，95%的患者进行了阻断，温/冷缺血时间的中位数分别为22和45分钟。在PN中，术前肾小球滤过率（GFR）的中位数为57 ml/min/1.73 m2，新的基线和5年GFR的中位数分别为47和48 ml/min/1.73 m2。PN的免透析生存率达到5年的97%。22名罹患清细胞肾细胞癌且RENAL指数≥10（中位数为11）的患者接受了酪氨酸激酶抑制剂（TKIs）以促进PN，并导致了57%的平均肿瘤体积减小；其中20人成功实现PN。41名患者计划行RN（4.0%），大多是由于严重的既往慢性肾脏疾病（CKD）所致；13名从PN转为RN（1.5%）。观察到80名（8%）Clavien III-V的围手术期并发症和90天死亡率为0.6%。PN，CA和RN的5年RFS分别为83%，80%和72%，其中 PN和RN之间的差异具有统计学意义（p = 0.03）。肾单位保存的措施在大多数单侧肾脏良性肿块患者中是可行且成功的。单侧肾脏良性肿块的PN常常具有挑战性，但可通过选择性使用TKIs来促进。由于严重的CKD，过度的肿瘤忧虑或PN转为RN等情况，有时也需要采用RN。这是首个对所有治疗方法/结果进行全面分析的大规模的单侧肾脏良性肿块研究。对于单侧肾脏癌的治疗来说，这是一个实现无癌症状态和避免透析的重大挑战。尽管PN是单侧肾脏良性肿块的主要治疗方法，但有时需要采用其他手段以优化疗效。版权所有©2022欧洲泌尿外科协会。由Elsevier B.V.出版。保留所有权利。

A renal mass in a solitary kidney (RMSK) has traditionally been managed with partial nephrectomy (PN), although radical nephrectomy (RN) is occasionally required. Most RMSK studies have focused on patients for whom PN was achieved.To provide a comprehensive analysis of the management strategies/outcomes for an RMSK and address knowledge deficits regarding this challenging disorder.A total of 1024 patients diagnosed with an RMSK (1975-2022) were retrospectively evaluated. Baseline characteristics and pathologic/functional/survival outcomes were analyzed.PN/RN/cryoablation (CA)/active surveillance (AS).Functional outcomes, perioperative morbidity/mortality, and 5-yr recurrence-free survival (RFS) were evaluated. Kruskal-Wallis and chi-square tests were used to compare cohorts, and log-rank test and Cox proportional hazard model were used for survival analysis.Of 1024 patients, 842 underwent PN (82%), 102 CA (10%), 54 RN (5%), and 26 AS (3%). The median tumor size and RENAL([R]adius [tumor size as maximal diameter], [E]xophytic/endophytic properties of tumor, [N]earness of tumor deepest portion to collecting system or sinus, [A]nterior [a]/posterior [p] descriptor, and [L]ocation relative to polar lines) score were 3.7 cm and 8, respectively. The median follow-up was 53 mo. For PN, 95% were clamped, and the median warm and cold ischemia times were 22 and 45 min, respectively. For PN, the median preoperative glomerular filtration rate (GFR) was 57 ml/min/1.73 m2, and the median new baseline and 5-yr GFRs were 47 and 48 ml/min/1.73 m2, respectively. Dialysis-free survival for PN was 97% at 5 yr. Twenty-two (2.1%) patients with clear-cell renal cell carcinoma and RENAL score ≥10 (median = 11) received tyrosine kinase inhibitors (TKIs) to facilitate PN, leading to 57% median decrease of tumor volume; PN was accomplished in 20 (91%). Forty-one patients had planned RN (4.0%), most often due to severe pre-existing chronic kidney disease (CKD), and 13 were converted from PN to RN (1.5%). Clavien III-V perioperative complications were observed in 80 (8%) patients and 90-d mortality was 0.6%. Five-year RFS for PN, CA, and RN were 83%, 80%, and 72%, respectively (p = 0.03 for PN vs RN).Nephron-sparing approaches are feasible and successful in most RMSK patients. PN for an RMSK is often challenging but can be facilitated by selective use of TKIs. RN is occasionally required due to severe CKD, over-riding oncologic concerns, or conversion from PN. This is the first large RMSK study to provide a comprehensive analysis of all management strategies/outcomes.Kidney cancer in a solitary kidney is a major challenge for achieving cancer-free status and avoiding dialysis. Although partial nephrectomy is the principal treatment for a renal mass in a solitary kidney, other options are occasionally required to optimize outcomes.Copyright © 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.